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AG 13-085RETURN TO: EXT: CITY OF FEDERAL WAY LAW DEPARTMENT ROUTING FORM l. ORIGINATING DEPT./DIV: CED/HS 2. ORIGINATING STAFF PERSON: DEE DEE CATALANo EXT: 2651_ 3. DATE REQ. BY: 4. TYPE OF DOCUMENT (CHECK ONE): O CONTRACTOR SELECTION DOCLJMENT (E.G, RFB, RFP, RFQ) � PUBLIC WORKS CONTRACT ❑ SMALL OR LIMITED PUBLIC WORKS CONTRACT ❑ PROFESSIONAL SERVICE AGREEMENT ❑ MAINTENANCE AGREEMENT ❑ GOODS AND SERVICE AGREEMENT X HUMAN SERVICES / CDBG ❑ REAL ESTATE DOCUMENT O SECURITY DOCUMENT (E.G. sorm xsi,n�n nocun�rrrs> ❑ ORDINANCE ❑ RESOLUTION ❑ CONTRACT AMENDMENT (AG#): ❑ OTHER 5. PROJECT NAME: T�vstTtoxa�. HousnvG PROG� ❑ INTERLOCAL 6. NAME OF CONTRACTOR: FUSION ADDRESS: TELEPHONE E-MAIL: FAX: SIGNATURE NAME: TITLE 7. EXHIBITS AND ATTACHMENTS: X sCOPE, WORK OR SERVICES X COMPENSATION X INSURANCE REQUIItEMENTS/CERTIFICATE � ALL OTHER REFERENCED EXHIBTTS X PROOF OF AUTHORITY TO SIGN ❑ REQUIItED LICENSES ❑ PRIOR CONTRACT/AMENDMENTS 8. TERM: COMMENCEMENTDATE: O1/O1/2013 COMPLETION DATE: 12/31/2014 9. TOTAL COMPENSATION $30,000 (INCLUDE EXPENSES AND SALES TAX, �,�1vY) (IF CALCULATED ON HOURLY LABOR CHARGE - ATTACH SCHEDULES OF EMPLAYEES TITLES AND HOLIDAY RATES) REIMBURSABLE EXPENSE: ❑ YES ❑ NO IF YES, MAXIMUM DOLLAR AMOUNT: $_ IS SALES TAX OWED ❑ YES ❑ NO IF YES, $ PAID BY: ❑ CONTRACTOR O CITY ❑ PURCHASING: PLEASE CHARGE TO: 001-7300-083-562-10-410: $13,500 001-7300-089-562-10-410: $1,500 10. DOCUMENT/CONTRACT REVIEW I1�iITI / DATE REVI WED I1�iITIAL / DATE APPROVED ❑ PROJECT MANAGER ❑ DIRECTOR ❑ RISK MANAGEMENT (g' �PLiCwar�) ❑ LAW �P ?� • l°� • 13 11. COUNCIL APPROVAL �IF APPLICABLE� COMMTTTEE APPROVAL DATE: COUNCIL APPROVAL DATE: 12. CONTRACT SIGNATURE ROUTING / ❑ SENT TO VENDOR/CONTRACTOR DATE SENT: �` ZS/� DATE REC'D: ❑ ATTACH: SIGNATURE ALTTHORITY, INSURANCE CERTIFICA E LICENSES, EXHIBITS ❑ LAW DEPARTMENT ❑ SIGNATORY (1vtAYOR DIRECTOR� ❑ CITY CLERK ❑ ASSIGNED AG# ❑ SIGNED COPY RETURNED COMMENTS: I1�TITIAL / DATE SIGNED � `�•22 •13 AG# -� DATE SENT: 11/9 ` CITY OF CITY HALL ,.'`.� Fe d e ra I Way 33325 8th Avenue South Federal Way, WA 98003-6325 (253) 835-7008 www. cttyoffederalway. com HUMAN SERVICES AGREEMENT FOR TRANSITIONAL HOUSING PROGRAM This Human Services Agreement ("Agreement") is made between the City of Federal Way, a Washington municipal corporation ("City"), and FUSION, a non-profit organization ("Agency"). The City and Agency (together "Parties") are located and do business at the below addresses which shall be valid for any notice required under this Agreement: FUSION CITY OF FEDERAL WAY: Peggy LaPorte Denise Catalano 1505 S. 356th St., Suite 104 33325 8�' Ave. S. Federal Way, WA 98003 Federal Way, WA 98003-6325 (253) 835-2651 (telephone) (253) 973-4033 (telephone) (253) 835-2401 (facsimile) la ort e ahoo.com denise.catalano cit offederalwa .com The Parties agree as follows: 1. TERM. The term of this Agreement shall be for a period of two (2) years coxnmencing on January 1, 2013 and terminating on December 31, 2014 ("Term"). Funding for the second year of the Agreement is contingent upon satisfactory Agreement performance during the first year of the Agreement term and upon funding availability. This Agreement may be extended for additional periods of time upon the mutual written agreement of the City and the Agency. 2. SERVICES. The Agency shall perform the services more specifically described in Exhibit "A", attached hereto and incorporated by this reference ("Services"), in a manner consistent with the accepted professional practices for other similar services within the Puget Sound region in effect at the time those services are performed, performed to the City's satisfaction, within the time period prescribed by the City and pursuant to the direction of the Mayor or his or her designee. The Agency warrants that it has the requisite training, skill, and experience necessary to provide the Services and is appropriately accredited and licensed by a11 applicable agencies and governmental entities, including but not limited to obtaining a City of Federal Way business registration. Services shall begin immediately upon the effective date of this Agreement. Services shall be subject, at all times, to inspection by and approval of the City, but the making (or failure or delay in making) such inspection or approval shall not relieve Agency of responsibility for performance of the Services in accordance with this Agreement, notwithstanding the City's knowledge of defective or non-complying performance, its substantiality or the ease of its discovery. 3. TERMINATION. Either party may terminate this Agreement, with or without cause, upon providing the other party thirty (30) days written notice at its address set forth above. The City may terminate this Agreement imxnediately if the Agency fails to maintain required insurance, breaches confidentiality, or materially violates Section 12, and such may result in ineligibility for further City agreements. 4. COMPENSATION. 4.1 Amount. In return for the Services, the City shall pay the Agency an amount not to excced a maximum amount and according to a rate or method as delineated in Exhibit "B", attached hereto and incorporated by this reference. The City sha11 reimburse the Agency only for the approved activities and in accordance with the pmcedures as specified in Exhibit "B". The Agency shall be solely responsible for the payment of any taxes imposed by any lawful jurisdiction resulting from this Agreement. HUMAN SERVICES AGREEMENT - 1- 4/2011 ` CITY OF ,'� Federal CITY HALL W�� 33325 8th Avenue South Federal Way. WA 980a3-6325 (253) 835-7000 www cityoTfederalway. com 4.2 Method of Pavment. On a quarterly basis, the Agency shall submit to the City an invoice for payment on a form provided by the City along with supporting documentation for costs claimed in the invoice and all reports as required by this Agreement. Payment shall be made on a quarterly basis by the City only after the Services have been performed and within forty-five (45) days after the City's receipt and approval of a complete and correct invoice, supporting documentation and reports. The City will use the quantity of Services actually delivered, as reported on the Agency's reports, as a measure of satisfactory performance under this Agreement. The City shall review the Agency's reports to monitor compliance with the performance measures set forth in Exhibit "A." Should the Agency fail to meet the performance measures for each quarter, the City reserves the right to adjust payments on a pro rata basis at any time during the term of this Agreement. Exceptions may be made at the discretion of the City's Human Services Manager in cases where circumstances beyond the Agency's control impact its ability to meet its service unit goals and the Agency has shown reasonable efforts to overcome these circumstances to meet its goals. If the City objects to all or any portion of the invoice, it shall notify the Agency and reserves the option to pay only that portion of the invoice not in dispute. In that event, the Parties will imxnediately make every effort to settle the disputed portion. 4.3 Final Invoice. The Agency shall submit its final invoice by the date indicated on Exhibit "B". If the Agency's final invoice, supporting docuxnentation, and reports are not submitted by the last date specified in Exhibit "B", the City shall be relieved of all liability for payment to the Agency of the amounts set forth in said invoice or any subsequent invoice; provided, however, that the City may elect to pay any invoice that is not submitted in a timely manner. 4.4 Bud�et. The Agency shall apply the funds received from the City under this Agreexnent in accordance with the line item budget set forth in E�ibit "B". The Agency sha11 request in writing prior approval from the City to revise the line item budget when the cumulative amount of transfers from a line item in any Project/Program E�ibit is expected to exceed ten percent (10%) of that line item. Supporting documents are necessary to fully explain the nature and purpose of the revision, and must accompany each request for prior approval. All budget revision requests in excess of 10% of a line item amount shall be reviewed and approved or denied by the City in writing. 4.5 Non-Appropriation of Funds. If sufficient funds are not appropriated or allocated for payment under this Agreement for any future fiscal period, the City will not be obligated to make payments for Services or amounts incurred after the end of the current fiscal period, and this Agreement will terminate upon the completion of all remaining Services for which funds are allocated. No penalty or expense shall accrue to the City in the event this pmvision applies. 5. INDEMNIFICATION. 5.1 A�v Indemnification. The Agency agrees to release, indemnify, defend, and hold the City, its elected officials, officers, employees, agents, representatives, insurers, attorneys, and volunteers harmless from any and all claims, demands, actions, suits, causes of action, arbitrations, mediations, proceedings, judgments, awards, injuries, damages, liabilities, ta�ces, losses, fines, fees, penalties expenses, attorney's fees, costs, and/or litigation expenses to or by any and all persons or entities, including, without limitation, their respective agents, licensees, or representatives arising from, resulting from, or in connection with this Agreement or the performance of this Agreement, except for that portion of the claims caused by the City's sole negligence. Should a court of competent jurisdiction determine that this Agreement is subject to RCW 4.24.115, then, in the event of liability for damages arising out of bodily injury to persons or damages to property caused by or resulting from the concunent negligence of the Agency and the City, the Agency's liability hereunder shall be only to the extent of the Agency's negligence. Agency shall ensure that each subcontractor shall agree to defend and indemnify the City, its elected officials, officers, employees, agents, representatives, insurers, attorneys, and volunteers to the extent and on the same terms and conditions as the Agency pursuant to this paragraph. The City's inspection or acceptance of any of Agency's work when completed shall not be grounds to avoid any of these covenants of indemnification. 5.2 Industrial Insurance Act Waiver. It is specifically and expressly understood that the Agency waives any immunity that may be granted to it under the Washington State industrial insurance act, Title 51 RCW, solely for the purposes of this indemnification. Agency's indemnification sha11 not be limited in any way by any limitation on the amount of damages, compensation or benefits payable to or by any third party under workers' compensation acts, disability benefit acts or any other benefits acts or programs. The Parties further acknowledge that they have mutually negotiated this waiver. HUMAN SERVICES AGREEMENT - 2- 4/2011 ` GTY OF � Federal CITY HALL ��� 3332� 8th Avenue South Federal Way, WA 98003-6325 (253) 835-7000 www atyoffederalway. com 5.3 Citv Indemnification. T'he City agrees to release, indemnify, defend and hold the Agency, its officers, directors, shareholders, partners, employees, agents, representatives, and sub-contractors harmless from any and all claims, demands, actions, suits, causes of action, arbitrations, mediations, proceedings, judgments, awards, injuries, damages, liabilities, losses, fines, fees, penalties expenses, attorney's fees, costs, and/or litigation expenses to or by any and all persons or entities, including without limitation, their respective agents, licensees, or representatives, arising from, resulting from or connected with this Agreement to the extent solely caused by the negligent acts, errors, or omissions of the City. 5.4 Survival. The provisions of this Section shall survive the expiration or termination of this Agreement with respect to any event occurring prior to such expiration or termination. 6. INSURANCE. The Agency agrees to carry insurance for liability which may arise from or in connection with the perFormance of the services or work by the Agency, their agents, representatives, employees or subcontractors for the duration of the Agreement and thereafter with respect to any event occurring prior to such expiration or termination as follows: 6.1. Minimum Limits. The Agency agrees to carry as a minimum, the following insurance, in such fomis and with such carriers who have a rating that is satisfactory to the City: a. Comxnercial general liability insurance covering liability arising from premises, operations, independent contractors, products-completed operations, stop gap liability, personal injury, bodily injury, death, property damage, products liability, advertising injury, and liability assumed under an insured contract with limits no less than $1,000,000 for each occurrence and $1,000,000 general aggregate. b. Workers' compensation and employer's liability insurance in amounts sufi'icient pursuant to the laws of the State of Washington; c. Automobile liability insurance covering a11 owned, non-owned, hired and leased vehicles with a minimuxn combined single limits in the minimum amounts required to drive under Washington State law per accident for bodily injury, including personal injury or death, and property damage. 6.2. No Limit of Liabilitv. Agency's maintenance of insurance as required by the agreement sha11 not be construed to limit the liability of the Agency to the coverage provided by such insurance, or otherwise limit the City's recourse to any remedy available at law or in equity. The Agency's insurance coverage shall be primary insurance as respect the City. Any insurance, self-insurance, or insurance pool coverage maintained by the City shall be excess of the Agency's insurance and shall not contribute with it. 6.3. Additional Insured, Verification. The City shall be named as additional insured on all commercial general liability insurance policies. Concurrent with the execution of this Agreement, Agency shall provide certificates of insurance for all commercial general liability policies attached hereto as Exhibit "C" and incorporated by this reference. At City's request, Agency shall furnish the City with copies of a11 insurance policies and with evidence of payment of premiums or fees of such policies. If Agency's insurance policies are "claims made," Agency sha11 be required to maintain tail coverage for a minimum period of three (3) years from the date this Agreement is actually terminated or upon project completion and acceptance by the City. 6.4 Survival. The provisions of this Section shall survive the expiration or termination of this Agreement. 7. CONFIDENTIALITY. All information regarding the City obtained by Agency in perFormance of this Agreement shall be considered confidential subject to applicable laws. Breach of confidentiality by the Agency may be grounds for ixnmediate termination. All records submitted by the City to the Agency will be safeguarded by the Agency. The Agency will fully cooperate with the City in identifying, assembling, and providing records in case of any public records disclosure request. 8. WORK PRODUCT. All originals and copies of work product, including plans, sketches, layouts, designs, design specifications, records, files, computer disks, magnetic media or material which may be produced or modified by Agency while performing the Services shall belong to the City upon delivery. The Agency make such data, documents, and files available to the City and shall deliver all needed or contracted for work product upon the City's request. At the expiration or termination of this Agreement all originals and copies of any such work product remaining in the possession of Agency sha11 be delivered to the City. HUMAN SERVICES AGREEMENT - 3- 4/2011 ` CITY OF ,�.. Federal CITY HALL W�� 33325 8th Avenus South Federal Way, WA 980�3-6325 (253) 835-7000 www. dfyoffederalway com 9. BOOKS AND RECORDS. The Agency agrees to maintain books, records, and docuxnents which sufficiently and properly reflect a11 direct and indirect costs related to the performance of the Services and maintain such accounting procedures and practices as may be deemed necessary by the City to assure proper accounting of a11 funds paid pursuant to this Agreement. These records shall be maintained for a period of six (6) years after the termination of this Agreement and may be subject, at a11 reasonable times, to inspection, review or audit by the City, its authorized representative, the State Auditor, or other governmental officials authorized by law to monitor this Agreement. 10. INDEPENDENT AGENCY. The Parties intend that the Agency shall be an independent Agency and that the Agency has the ability to control and direct the performance and details of its work, the City being interested only in the results obtained under this Agreement. The City shall be neither liable nor obligated to pay Agency sick leave, vacation pay or any other benefit of employment, nor to pay any social security or other tax which may arise as an incident of employment. Agency shall take all necessary precautions and shall be responsible for the safety of its employees, agents, and subcontractors in the performance of the Services and work and shall utilize all protection necessary for that purpose. All work sha11 be done at Agency's own risk, and Agency shall be responsible for any loss of or damage to materials, tools, or other articles used or held for use in connection with the work. The Agency shall pay all income and other taxes due except as specifically provided in Section 4. Industrial or any other insurance that is purchased for the benefit of the City, regardless of whether such may provide a secondary or incidental benefit to the Agency, shall not be deemed to convert this Agreement to an employment contract. 11. CONFLICT OF INTEREST. It is recognized that Agency may or will be performing services during the Term for other parties; however, such performance of other services shall not conflict with or interfere with Agency's ability to perform the Services. Agency agrees to resolve any such conflicts of interest in favor of the City. Agency confirms that Agency does not have a business interest or a close family relationship with any City officer or employee who was, is, or will be involved in the Agency's selection, negotiation, drafting, signing, administration, or evaluating the Agency's performance. 12. EQUAL OPPORTUNITY EMPLOYER In all services, prograrns, activities, hiring, and employment made possible by or resulting from this Agreement or any subcontract, there shall be no discrimination by Agency or its subcontractors of any level, or any of those entities' employees, agents, sub-agencies, or representatives against any person because of sex, age (except minimum age and retirement provisions), race, color, religion, creed, national origin, marital status, or the presence of any disability, including sensory, mental or physical handicaps, unless based upon a bona fide occupational qualification in relationship to hiring and employment. This requirement shall apply to, but not be lixnited to, the following: employment, advertising, layoff or termination, rates of pay or other forms of compensation, and selection for trairung, including apprenticeship. Agency shall comply with and shall not violate any of the terms of Chapter 49.60 RCW, Title VI of the Civil Rights Act of 1964, the Americans With Disabilities Act, Section 504 of the Rehabilitation Act of 1973, 49 CFR Part 21, 21.5 and 26, or any other applicable federal, state, or local law or regulation regarding non-discrimination. 13. GENERAI� PROVISIONS. 13.1 Interpretation and Modification. This Agreement, together with any attached Eachibits, contains all of the agreements of the Parties with respect to any matter covered or mentioned in this Agreement and no prior statements or agreements, whether oral or written, shall be effective for any purpose. Should any language in any Exhibits to this Agreement conflict with any language in this Agreement, the terms of this Agreement shall prevail. The respective captions of the Sections of this Agreement are inserted for convenience of reference only and shall not be deemed to modify or otherwise affect any of the provisions of this Agreement. Any provision of this Agreement that is declared invalid, inoperative, null and void, or illegal shall in no way affect or invalidate any other provision hereof and such other provisions shall remain in full force and effect. Any act done by either Pariy prior to the effective date of the Agreement that is consistent with the authority of the Agreement and compliant with the terms of the Agreement, is hereby ratified as having been performed under the Agreement. No provision of this Agreement, including this provision, may be amended, waived, or modified except by written agreement signed by duly authorized representatives of the Parties. 13.2 Assignment and Beneficiaries. Neither the Agency nor the City sha11 have the right to transfer or assign, in whole or in part, any or a11 of its obligations and rights hereunder without the prior written consent of the other Party. If the non- HUMAN SERVICES AGREEMENT - 4- 4/2011 � CITY QF � Federal CITY HAIL ��� 33325 8th Avenue South Federal Way, WA 98003-6325 (253) 835-7000 www cityoffederahaay com assigning party gives its consent to any assignment, the terms of this Agreement shall continue in full force and effect and no further assignment shall be made without additional written consent. Subject to the foregoing, the rights and obligations of the Parties shall inure to the benefit of and be binding upon their respective successors in interest, heirs and assigns. This Agreement is made and entered into for the sole protection and benefit of the Parties hereto. No other person or entity shall have any right of action or interest in this Agreement based on any provision set forth herein. 133 Compliance with Laws. The Agency shall comply with and perform the Services in accorda.nce with all applicable federal, state, local, and city laws including, without limitation, all City codes, ordinances, resolutions, regulations, rules, standards and policies, as now existing or hereafter amended, adopted, or made effective. If a violatioa of the City's Ethics Resolution No. 91-54, as amended, occurs as a result of the formation or performance of this Agreement, this Agreement may be rendered null and void, at the City's option. 13.4 Enforcement. Time is of the essence of this Agreement and each and a11 of its provisions in which performance is a factor. Adherence to completion dates set forth in the description of the Services is essential to the Agency's performance of this Agreement. Any notices required to be given by the Parties shall be delivered at the addresses set forth at the beginning of this Agreement. Any notices may be delivered personally to the addressee of the notice or may be deposited in the United States mail, postage prepaid, to the address set forth above. Any notice so posted in the United States mail shall be deemed received three (3) days after the date of mailing. Any remedies provided for under the terms of this Agreement are not intended to be exclusive, but shall be cumulative with all other remedies available to the City at law, in equity or by statute. The failure of the City to insist upon strict performance of any of the covenants and agreements contained in this Agreement, or to exercise any option conferred by this Agreement in one or more instances shall not be construed to be a waiver or relinquishment of those covenants, agreements or options, and the same shall be and remain in full force and effect. Failure or delay of the City to declare any breach or default immediately upon occurrence shall not waive such breach or default. Failure of the City to declare one breach or default does not act as a waiver of the City's right to declare another breach or default. This Agreement shall be made in, govemed by, and interpreted in accordance with the laws of the State of Washington. If the Parties are unable to settle any dispute, difference or claim arising from this Agreement, the exclusive means of resolving that dispute, difference, or claim, shall be by filing suit under the venue, rules and jurisdiction of the King County Superior Court, King County, Washington, unless the parties agree in writing to an alternative process. If the King County Superior Court does not have jurisdiction over such a suit, then suit may be filed in any other appropriate court in King County, Washington. Each pariy consents to the personal jurisdiction of the state and federal courts in King County, Washington and waives any objection that such courts are an inconvenient forum. If either Party brings any claim or lawsuit arising from this Agreement, each Party shall pay all its legal costs and attorney's fees and expenses incurred in defending or bringing such claim or lawsuit, including all appeals, in addition to any other recovery or award provided by law; provided, however, however nothing in this paragraph shall be construed to limit the Parties' rights to indemnification under Section 5 of this Agreement. 13.5 Execution. Each individual executing this Agreement on behalf of the City and Agency•represents and warrants that such individual is duly authorized to execute and deliver this Agreement. This Agreement may be executed in any number of counterparts, each of which sha11 be deemed an original and with the same effect as if all Parties hereto had signed the same docuxnent. All such counterparts shall be construed together and shall constitute one instrument, but in making proof hereof it sha11 only be necessary to produce one such counterpart. The signature and acknowledgment pages from such counterparts may be assembled together to form a single instrument comprised of a11 pages of this Agreement and a complete set of all signature and acknowledgment pages. The date upon which the last of all of the Parties have executed a counterpart of this Agreement shall be the "date of mutual execution" hereof. [Signature page follows] HUMAN SERVICES AGREEMENT - 5- 4/2011 �_ ` CITY OF , ',�,,�..., Federal Way CITY HA�L 33325 8th Avenue South Federal Way, WA 98003-6325 (253) 835-7000 www cityoffederalwaay. com IN WITNESS, the Parties execute this Agreement below, effective the last date written below. CITY OF FEDERAL WAY Patrick Do , Director Community & Economic Develop ent Services DATE: ��/ " / �% FUSION I: �r� ► `�• � � �. 9 _ �_ I' '� �: u�.�c! .�_��',l DATE: �IIS � �3 STATE OF WASHINGTON ) ) ss. COUNTY OF t n ATTEST: City Clerk, Carol McN lly, APPROVED AS TO FORM: � �� City Att y, Patricia A Richardson On �s day personally appeared before � me Rc�il.�" �['pJ� � tc.�3�- , to me known to be the rl S,c ci v�t' of K� �* that executed the foregoing instrument, and acknowledged the said instrument to be the free and voluntary act and deed of said corporation, for the uses and purposes therein mentioned, and on oath stated that he/she was authorized to execute said instrument and that the seal affixed, if any, is the corporate seal of said corporation. GIVEN my hand and official seal this � day of i�oQ.i c� , 2013. _`��``�N �i'�`�;��,.,,�����'�h �i, �pT,`�P�'•��i A �._ �� �► �i���G 7%� 9 p�� � 5��t_ �`- ���ilii{tl�� �pi� h,A� ri�' Notary's signature � Notary's printed name a.,� L. � t�" ecr Notary Public in and for the State of Washington. My commission expires 9'�I - 13 HUMAN SERVICES AGREEMENT - 6- 4/2011 � CITY OF "�.�..., Federal Way EXHIBIT ��A" SERVICES Project Summary CITY HALL 33325 8th Avenue South Federal Way, WA 98003-6325 (253) 835-7000 �naw. dryoffederahvay. com The Agency shall provide transitional housing in the City of Federal Way. The Agency shall ensure that services provided with funding under this Agreement are made available to Federal Way residents. Performance Measures A. Number Served The Agency agrees to serve, at minimum, the following unduplicated number of Federal Way residents with Human Services funds: ls` Quarter 2°d Quarter 3'd Quarter 4th Quarter JAN. — MARCH APRIL - d[JNE NLY — SEPT. OCT. — DEC. TOtSI No. of unduplicated Federal Wa ersons assisted in 2013 4 4 4 3 15 No. of unduplicated Federal Wa ersons assisted in 2014 4 4 4 3 15 B. Units of Service The Agency agrees to provide, at minimum, the following units of service by quarter: ls` Quarter 2°d Quarter 3''d Quarter 4th Quarter JAN. - MARCH APRIIr J[JNE NLY — SEPT. OCT. —DEC. TOt81 2013 1. Case Management 1 1 1 2 5 2. 2014 1. Case Management 1 1 1 2 5 2. HUMAN SERVICES AGREEMENT - 7- 4/2011 ` CITY OF .'�.. Federal C. Definition of Services CITY HALL W�� 33325 8th Avenue South Federal Way. WA 98003-6325 (253) 835-7000 www. atyoi�ederalway com 1. Case Management: One service unit is case management for one family for one year. FUSION contracts with CCS to provide support services for an annual cost invoiced at a flat fee per household per month. The service is delivered at the client's home and the time and specific support varies with each client's needs and goals. D. Outcome(s) Outcome(s) to be reported: 1. Individuals and/or families will have secure housing. Records A. Project Files The Agency shall maintain files for this project containing the following items: 1. Notice of Grant Award. 2. Motions, resolutions, or minutes documenting Board or Council actions. 3. A copy of this Agreement with the Scope of Services. 4. Correspondence regarding budget revision requests. 5. Copies of all invoices and reports submitted to the City for this project. 6. Bills for payment with supporting documentation. 7. Copies of approved invoices and warrants. 8. Records documenting that costs reimbwsed with funding provided under this Scope are allowable. Such records include, but are not limited to: ■ for personnel costs, payroll for actual salary and fringe benefit costs. ■ for staff travel, documentation of mileage charges for private auto use must include: a) destination and starting location, and b) purpose of trip; and ■ for copy machine use, postage, telephone use, and office supplies when these costs are shared with other programs and no invoice is available, log sheets or annotated invoices. HUMAN SERVICES AGREEMENT - 8- 4/2011 � CITY OF � Federal � CITY HALL ��� 33325 8th Avenue South Federat Way, WA 98003-6325 (253) 835-7000 www. cityoftederahvay. com Documentation of client income. The Agency agrees to use the HUD Income Guidelines to report income of clients served under this Agreement. Income guidelines may be adjusted periodically by HUD. , ., Y , �, :. , : �_ . � w � ,� < � King �aur�tYi FY 2t113"Meorr�e Limits 5ucrtm�ry Effective f2fy1�/20�2 � Median �ncome 1 2 3 4 5 6 7 8 Income �imit person Persons Persons Persons Persons Persons Persons Persons Category Extremely Low (30%) $18,200 $20,800 $23,400 526,000 $28,100 $30,200 $32,250 $34,350 Income Limits Very Low $86.700 (50%) Income $30,350 $34,700 $39,050 $43,350 $46,850 $50,300 $53,800 $57,250 Limits Low (80�� $45,100 $51,550 $58,000 $64,400 $69,600 $74,750 $79,900 $85,050 Income Limits The Agency agrees to use updated Income Guidelines which will be provided by the City. Reports and Reporting Schedule The Agency shall collect and report client information to the City quarterly and annually on a Service Unit Report to be provided by the City in the format requested by the City. The Agency shall submit an Annual Demographic Data Report. The agency shall collect and retain the data requested on this form from the persons served through this contract. Data should be tracked in an ongoing manner and submitted annually no later than January 15 in the format requested by the City. The Agency shall implement and track at least one measurable outcome for the program as presented in the application. Changes to the outcome presented in the application must be approved by the City prior to implementation. The Agency shall report the results of its outcome measure(s) annually on the Annual Outcome Data Report to be submitted by January 15 in the format requested by the City. Public Information In all news releases and other public notices related to projects funded under this Agreement, the Agency will include information identifying the source of funds as the City of Federal Way Human Services General Fund Program. HUMAN SERVICES AGREEMENT - 9- 4/2011 � CITY OF CITY HALL ,,:'�.., Fe d e ra I Way 33325 8th Avenue South Federal Way, WA 98003-6325 (253) 835-7000 w�vw. dtyoffederalwsy. com EXHIBIT KB» COMPENSATION Project Budget The Agency shall apply the following funds to the project in accordance with the Line Item Budget Summary. The total amount of reimbursement pursuant to this Agreement shall not exceed $30,000 A. City of Federal Way Funds 2013 2014 Ci of Federal Wa General Fund: $15,000 $15,000 Total Ci of Federal Wa Funds: $15,000 $15,000 B. Line Item Bud et 2013 2014 Personnel Services (detail below $ $ Office or O eratin Su lies $ $ Rent & Utilities $ $ Communications $ $ Travel and Trainin $ $ Other: Case Mana ement CCS $15 000 $15 000 Client Travel $ $ Administration Overhead $ $ Total Ci of Federal Wa Funds: $15,000 $15,000 C. Personnel Detail Position Title Position Full Annual Salary HS Funds Time E uivalent and Benefits n/a Total: $ $ Reimbursement Requests and Service Unit Report forms shall be submitted no less frequently than quarterly and are due on the following dates: 1 st Quarter: April 15 or within 10 days of notice to proceed, whichever is later; 2nd Quarter: July 15; 3rd Quarter: October 15; and 4th Quarter: Final Reimbursement Request and Service Unit Report forms due January 8; Demographic Data Report and Annual Outcome Data Report with supporting documentation due January 15. The Agency shall submit Reimbursement Requests in the format requested by the City. Reimbursement Requests Invoices shall include a copy of the Service Unit Report and any supporting documents for the billing period. HUMAN SERVICES AGREEMENT - 10 - 4/2011 ` CITY OF � Federal Estimated Quarterly Payments: 2013 1 st Qtr 2nd Qtr 3rd Qtr 4th Qtr 2014 1 � Qtr 2na Qtr 3'� Qtr 4�' Qtr $3,750 $3,750 $3,750 $3,750 $3,750 $3,750 $3,750 $3,750 CITY HALL W�� 33325 8th Avenue South Federai Way, Wp 9$003-6325 (253} 835-�000 www cityoffederahaay. com Expenses must be incurred prior to submission of quarterly reimbursement requests. Proof of expenditures must be attached to the reimbursement request for invoice to be approved. Quarterly reimbursement requests sha11 not exceed the estimated payment without prior written approval from the City. Estimated quarterly payments are contingent upon meeting or exceeding the above performance measure(s) for the corresponding quarter. This requirement may be waived at the sole discretion of the City with satisfactory explanation of how the performance measure will be met by year-end on the Service Unit Report. Conditions of Funding The Agency agrees that it will meet the specific funding conditions identified for the Agency and acknowledges that payment to the Agency will not be made unless the funding conditions are met. The Agency is responsible for meeting the applicable portions of the funding conditions adopted as part of the 2013-14 Human Services General Fund Allocation Process including: No Conditions. HUMAN SERVICES AGREEMENT - 11 - 4/2011 � CITY OF �, Federal Way CITY HALL 33325 8th Avenue South Federal Way, WA 98003-6325 (253)835-7d00 www. atyoffederahvay. com City of Federal Way Human Services Contract for 2013-2014 General Fund Authorized Signatures for Invoices I authorize the following individuals to sign invoices and quarterly reports on behalf of: � for the following: Authorizing Signature: (must be signed by person who signs the contract, genera/ly, Executive Director) ' G �L > � (Printed Name) (Signature) r , (Contracting Agency), �^ (Program Title). 4I�1►� (Title) q� 51 �3 (Date) ..................................................................................................... _.................................................................................................................................................................................................... m.. �.......... �...... �... _............ _.., Additional Aufhorized Signature: Additional Aufhorized Signature: (Printed Name) ` � (Title) � - - (Printed Name) (Title) (Signature) (Date) Note: It is the responsibility of the contractor to inform the City of Federal Way if they wish to add a name to or delete names from this list. Corporations: Registration Detail Page 1 of 2 � ContactUs�Connea: � � � � ���� � SEARCH Corporations and Charities Division ':, Corporations Home j Nonprofit Home i Charities Home ; Awards i Public Notices � Contact Info : ; � i ' --------- ------ �------ ------ ----- -- ------- - -- - - __ ---- --1--------- ' - -- --- -- Corporation Detail Neither the State of Washington nor any agency, officer, or employee of the State of Washington warrants the accuracy, reliability, or timeliness of any information in the Public Access System and shall not be liable for any losses caused by such reliance on the accuracy, reliability, or timeliness of such information. While every effort is made to ensure the accuracy of this information, portions may be incorrect or not current. Any person or entity who relies on information obtained from the System does so at his or her own risk. All documents filed with the Corporations Division are considered public record. FUSION/FRIENDS UNITED TO SHELTER THE INDIGENT, OPPRESSED AND NEEDY UBI Number Category Profit/Nonprofit Active/Inactive State OfIncorporation WA F`iling Date Fxpiration Date Inactive Date Duration Charity 602388063 REG Nonprofit Active WA 04/20/2004 04/3o/2oi3 Perpetual This corporation is aLso a charity. View Info � Registered Agent Information Agent Name Judith Free Address 374a2 4oth Ave S City State ZIP Special Address Informarion Address City State Zip Governing Persons Title Secretary President Vice President T'reasurer AUBURN WA 9800i PO BOX 23934 FEDERAL WAY WA 98093 Name Dillon, Pat WROBLEWSKI, BOB Jaenicke, Nancy HORNER, RALPH Address 4303 S 3ooth PI AUBURN, WA 9800i 3i826 48TH CIRCLE SW FEDERAL WAY, WA 98023 5536 Broadview Ave SW TACOMA, WA 98422 http://www. sos.wa.gov/corps/search_detail.aspx?ubi=6023 88063 4/18/2013 Corporations: Registration Detail Page 2 of 2 ioi5 6yi'H Ave CT E FIFE, WA 98424 Purchase Documents for this Corporadon » « Return to Search List Phone Numbers � Privacy Policy � Accessibility Washington Secretary of State • Corporations Division 8oi Capitol Way South PO Box 40234, Olympia WA 98504-0234 (360)725-0377 Translate our site into: Select Language Powered by C;a�g1e Trenslate http://www.sos.wa.gov/corps/search_deta.il.aspx?ubi=602388063 4/18/2013 ti 20p9 Merged Organization By-Laws FINAL the second or third year of their tenure on the board, they will automatically be continued on the board for the three-year period of the presidential suacession. The three year term of Presidency shall consist of the first year as Vice Presiden� the second year as President; and the third year as Past Presiden#. At the annual election a new Vice President will be elected and will automatically sacceed to tl�e position as President Sa�ion 3: Nominations and Ele�tions — Elections shall be held annually. T� President shall appoint a Nominating Committee, wluch will include the Volu�eer Coordinatar. The Nominatiag Commit�ee will pre�nt a slate of caadidat�es for the vacaut Board positions and interview all potentiai Board members. The elections will be held at a regtilar Board meeting during the fourth qczarter of each year. Nonninations c�n also be made from the floor at the Ao�rd meebng. The Nomina�ing Committee will id�mtify a sl�te of o�cers within the Bosrd candidates listing. Offioer �mi�tions c�n also be m�de from tl�e floor. Section 4: varanc9 — Should an out-of-sequence va�cy in the Board of Directors occur, the Presid�ent will �opose a c+eplac�eit�tnt to serve thmugh the n:mai�er of the tierm. The remaining members of the Board sl�all vote on the nomination. If the va+c�cy is the cu�nt Presideut, the Vice President will propose the Board member nplevement. If tbe out-of-sequ�enae vaca�y iavolves the pm�at succession office, tl�e board wt�t dxide tb�e Yive Pc+�ideat or P�t; replsoement who v�l serve on the board for the �g time of th� r�plaoed pc�on's �CSidentiai sequenoe. There will be a Board, but not aa officer replaceme�t, for an out-of sequsrnoe vacating Past President office. Sectioa 5: Vating — Each Board Member present shall have one vote. Where more thau one per�on shares a Boaid position, only one vote is designatod for that position �A simple majority shall g+overn all voting eaoept in th+e c�se of board ma�ber reo�ovat (see secti� 9). Note: See Sec�ion 1 Tl�.e Board mast always have an odd number of inembers. Satian 6: Daties - Offtc�xs shali assttme their electeci positions at the 3aauery meeting. Officers will sx aa o�derly transition of information aa�d materiais to the new of�cers. Sectiva 7: Compensation - Bosrd members serve with no compensa�ion other than reasonable expenses. 3wch �ents are made when saba�itted ia aocoz+dance with pmocedtu+es �scn'bed by the Finacrce Committ�ee. Sectiae 8: R�ttion, Termiuition and Abse�as - Resigna#iaa from th�e Bosid me�st be in writing and ncxivod by thc Board Presidcnt and Secretary. Founders may only be terminated by voluntary resig�tioa Any ott�er board member shall be dropped for exoess absececes from the Bosid if there are three unexcused absences from Board meetings in one caleadar year. Aay othe�r Board memba m�y aLSO be removed for other reasons by a thc+e�-fourths vote of tl�e i'�siain8 di�tors- �.TICLE VIII — EXECUTIVE BOARD T[�e Execirtive Board is empowered to �ct when the full board cannot or is unavailable. The Fxxutive Board will consist of the following: Saetion 1: Piir�iieeR — The Presideat s�all be the pri�ipal executzve officer of the arganizatioa and slsall, in 8�ra1, s�se aad c�aatrol all of the busi�eess affairs of the or�on. Tl�e Pres�dent's duties s1�ai1 include, but not be timit,ed to: • Signing all docu�nts n+oc,cssaiy tv cany on t� business and mission of FUSION, and • Presiding at all of the mecdngs of �e Baard of Diroctors, Executive Board and the Advisory Boar�. • Airthori�zang �nd appointing i�dividua}s to Spociat Committees • 5��8 and mo�tozing the a,ities ana. pezform�nces of any paid pe�On�i. 2 s�42� , , : � 20()9 Mergcd Organization By-Laws F1NAL The out-going President will continue to be a voting member of the board, but not a member of the Executive Boazd during the overlapping year. The autgoing President will be identified as the "p�st President". The past President's duties shall include but not be limited to: • Consultstion with the President at the President's request, and • Special assigamcnts and pffiticipatian on various committe�e.s at the President's reqwest. S�ction 2: Vioe Praident — The duties of the Vice Pr�esident shali include, but aat be limitcd to • In the absenoe of the Presideat, performing the duties of the President, • Orgaaizing the spring and Fall reereats for the Board, • Reviewing the strategic plsa on ��nusl basis, and • Updating by-laws and job de.scriptions with the President ss nceded. Section 3: Board Sa�ry — The duki.es ofthe Baard Sec�etary shall inalude, but not be limited to � Recading tlte mirnibes at all of the meetings of tt�e Boazd of Dmecbo�rs, Executiva Board and the Advisory Board, • Distn'buting the minukes of each mecting Board and Advisory member within 14 days of the me�xing, • Filing initialod copits of the minirtes in the FUSION office, ,, • Assisting tlbe Officx Manager es aoo�od and be fsmiiisr with FUSION office Sles and supplies, � Tracking the hour to assist the President to end tl�e meeting on time, and • Maintaiaing an up-� roster of Board membcrs, inclu�ding their address, telephone, cell phone, e-mail a�d other cantact inforniation Section 4: Trr,asarer — The duties of the Tre,asorer sball i�clude, but not be limited to • Monitoring die finanoes, sad work clo�ely with the o�ice staff aa�d t�e bookkeeperf�dminisdrative assistant whs� applicable, • Being responsi'ble for th,e payment of outstandiag bills in a timely manner, • Balaacing the bank statemeats, • Issuing a mo�hiy financial statemeat to the Board, � Bala�rcing ti�e pest year's y�ear-to-date fi�eecial repcnt in Janunry, and • E,nsining the Fo�m 990 is Sled in a tumely nusa�n�r. Sec�ton 5: Foaadera — The Foundeis shall focas on fimd raising and increasiag awareness of tl�e organizations mission. ARTICLE IX — ADVISORY COiJ�TCII. Section 1: Tt�e Advisary Co�cil sbsll offierr in�t and advic:e in areas of expertise and suggest resowces for spxific projects. The Advisary Council has no decisio�maicing authority. Sec�ion 2: T!� Advisory Counc� s�all consist of at least nine members of the community sele�ted by the Board members of FLTSION. Section 3: The Advisory Council s�all meet at least once per year with the FUSION board at a time and location selected by the board. ARTICLE X— FIN�NCE COMMITTEE Th�e Finance Committee c�nsists of t�e following Bou+d membeis: Treasurer, Presideat, Past Preside�, Off ce Manage.r aad others as designated by the Presideirt. Ih�ties include, but are not lirnited to: • Monitoring the acoounting and control systems of the organizatioq • Accountability to the Board for finsacial activities, • Fstablishing a�d implementrng reimb�arseme� procodures, 3 s�a2oos tr�o?t �I��ifs: lnsurance Pr�grarra . . Non Profit Insurance Program Coverage Confirmation The limi�s and coverages shown here are brief overviews of the coverage provided by the Non Profit /nsurance Program. The i�erms and conditions of%neal may dff%r from �rour prfor polfcy and from what you requested in y�our submission. This document is not intended to be used as a dir�ect r+eflecfion of alI coverages or to replace or alter the policies in any way. All specilic coverage, exclusion, and limitation questfons should be referned dir�ectiy to the policies and aH attached endorsements. A specfinen policy is availab/e upon reques� lnfonr►ation r+epiesenfied in this Coverage Confirntatfon ls subject t� the excluslons, tern►s, lim/ta�ons, and conditions of the po/lcy insuring the Non Profit Insurance Progrem. P/ease remember coverage is not bound without written confirmation from an authorized r�spresentative of Canfie/d. h is ifie responsibiltty of the broker to review ifiis document to confirm its accuracy. Policy Period: 06/01/2012 to 06/01/2013 Coverage Conflnr�ation Expiration Dafie: 08/29/2012 at 12:01 a.m. Member Since: 05/18/2005 Authorized Signature: � / r �. / Administered by Canfieid NPIP Coverage Confirmation Page 1 of 11 5/4J2012 Fusion Doc �: 2600782 •;�i i.lil t�'l f9i i ,. lr,suranc� �rc,gr�rr Non Profit Insurance Program Coverage Confirmation �;�,�,.,.� , � ,�;� k -� x�-,� �, � �,- �r i k 4 - — it�[i � �ii BOX Z$�� - Federal Way, WA 98093 Member Coverage Number: NPIP121333442 Tota! Properly Value: $2,138,838 Totat Vehicie Count Excluding Trailera: p Total Inland Marine Value: �� The camplete SOV, Vehicle, and tnland Marine Schedules are included in the Coverage Confirntation �;. ` '"` �° ��'� s� s ��y � � ry Jack Staai�ord �k Stanford Insurance, tnc. 1010 S 338th St, Ste.110 Federal Way, WA 9$003 NPIP 5/4�2012 Administered by Canfield Coverage Confirmation Fusiw� Page 2 of 11 Doc �: Z�0782 Non Profit Insurance Program Commercial Pro e Insurance Covera e Insurance Carrier American Alternative Insurance Corp, a member of Munich-American Holding Corporation AM Best's Rating A+ XV Program Policy Number N1-A2-RL-0000013-04 Policy Period 6/1/2012 to 6/1/2013 All risks of direct physical loss or damage to covered Perils property, subject to standard form exclusions, including earthquake and flood per special form coverage. Program Retentions $50,000 all Perils Except Earthquake and Flood Each Occurrence •$500 all Perils Except Earthquake and Flood Eadi Occurrence. •$250 Personal Property of Employees — Damage & Theft. Member Deductibles • Earthquake: 2% of insurable values, subject to a $25,000 minimum, Each Member, Each Occurrence. • Flood: 2°r6 of insurable values, subject to a$25,000 minimum and $100,000 maximum, Each Member, Each Occurrence, excluding Flood Zones pr�xed "A' O� "�%. Co-Insurance None �.5: �� ; ��� � �r,-..� ��� �3t�lt - � ,_ _ .. All Risks of Direct Physical Loss or Damage, $50,000,000 Each Occunence Maximum Each Occurrence tProperty is c�vered up to the values schedu/ed per the Statement of Values on frle, with 12596 Margin Clause.) �� ��' � Accounts Receivable / Valuable Papers — Each $�00,000 Coverage, Each Occurrence, Each Member Business Income with Extra Expense $250,000 btanket limit for each member. Additional Each Occurrence, Each Member BI/EE to be scheduled on SOV per member. Business Income 8 Extra Expense for Utility Service Interruption $250,000 Each Occurrence, Each Member Computer Systems, Each Occurrence, Each Member $1,000,000 Electronic Data & Media, Each Occxarrence, Each Member $250,000 Computer Systems and Eleetronic Data & Media, $10,000,000 Group Annual Aggregate Contractors' Equipment , Each Occurrence, Each Member $100,000 Debris Removal Expense, Each Occurrence, Each Member 20°� of loss, up to $500,000, whichever is less. "Sublimits Do Not Increase Overall Policy Limits Shown Above NPIP Coverage Co�'irmation Page 3 of 11 5/4J2012 Fusion Doc #: 2600782 Non Profit Insurance Program r , � v. t < ,. , .,x �� fi;, ,.�����i�� ����'� ������� f��'����� , COVera @ $Ubllmits* Fine Arts, Each Occurrence, Each Member $100,000 Newly Acquired or Constructed Property Each Occurrence, Each Member $1,000,000; 180 days Personal Property in Transit, Each Occurrence, $100,000 Each Member Poilutant Clean Up and Removal, Each Member, $�� 000 Group Annual Aggregate Property Off Premises/Unnamed Locations $250,000 Each Occurrence, Each Member Personal Property pwned by an Employee $50,000 Each Occurrence Per Employee Limit -$5,000 Personal Property Owned by an Employee $250,000 Group Annual Aggregate Personal Property of Others $50,000 Group Annual Aggregate Per Person Limit -$5,000 ArtificiaUPaved Surtaces, Each Occurrence, $200,000 Each Member Fire Department Service Charge, $25,000 Each Occurrence, Each Member Sewer, Drain or Sump Badc-up or Overflow, $25,000 Each Occurrence, Each Member Earthquake Each Occurrence and Aggregate per $� �� Member Earthquake Annual Program Aggregate $25,000,000 Flood Each Occurrence and Aggregate per Mem�� $1,0�,000 Flood Annuat Program Aggregate Coverage for all locations except those in NFIP Zones $25,�0,000 prefixed "A" & "V " Auto Physical Damage — while in storage or not over $2��,� the road, Each Occurrence Terrorism Included � ti�;,� (�y�,j�,�.��yy� � � � �, � �.� . ,7 ��AR�YvsR '# t x � i ry-'SG��yy t t� .. . . , .. . , d . . . i . _ .. . .. ... Buildings & Personal Property - Replacement Cost *Sublimits Do Not Increase Overall Policy Limits Shown Above NPIP Coverage Confirmation Page 4 of 11 5/4/2012 Fusion Doc #: 2600782 Non Profit Insurance Program cyu����� c�r���vc�r�nr� �:nr�urar�c�r v��v�ra8� , , � Insurance Carrier American Altemative Insurance Corp, a member of Munich-American Holding Corporation AM BesYs Rating A+ XV Policy Number N1-A2-RL-0000013-04 Policy Period 6/1/2012 to 6/1/2013 Equipment that generates, transmits or utilizes energy, including electronic communications and data processing Covered Equipment equipment; or equipment which, during normal usage, operates under vacuum or pressure, other than the weight of its contents. Program Retention �'� Each Occurrence Service Interruption - 24 Hours Member Deductiblea $1,� Each Occurrence Service Interruption - 24 Hours � � Equipment Breakdown $50,000,0� Each Occurrence, Each Member Program Aggregate None i ,`?, y � ���:� l�,t ;�.� ��, . , c ....,.:. . Off Premises Property Damage $100,000 Business Income Included Extra Expense Combined with Business Income Service Interruption $100,000 Contingent Business Income $100,�0 Spoilage $100,000 Electronic Data Restoration $100,0� � Ordinance or Law Follows Property Expediting Expenses $100,000 Hazardous Substances $100,000 Newly Acquired Locations Follows Property; 180 days Extended Period of Restoration 60 days Terrorism Included '"'Sublimits Do Not Increase Overall Policy Limits Shown Above NPIP Coverage Confirrmation Page 5 of 11 5/4/2012 p�� Doc �F: 2600782 Non Profit Insurance Program „a4 .. � . .y „� . : ._ ::. �_; <. ; `. .e. R � 1--: �:q�� �a3 :��^?3,d : ��a ��►rn�rc�rn�se tnsurr�►nce Coverag� Insurance Camer American Altemative Insurance Corp, a member of Munich-American Holding Corporation AM Best's Rating A+ XV Policy Number N1-A2-RL-0000013-04 Policy Period 6i112012 to 6/1/2013 Response Expenses -$2,500 per Personal Data Member Deductibles �mpromise Defense & Liability -$2,500 per Data Compromise Suit Response Expenses: Discovery by the insured that personally identifying ir�formation in the insured's care, custody, or control has been lost, stolen or inadvertently made public. Coverage Triggers Defense and Liability: Suit brought by one or more "affected individuals" within two years of the not�cation of breach as provided under the Response Expenses coverage: �� . , , � � ��, "'I gt" s �4:p �.'..n�s'z Response Expense, Member Annual Aggregate * Coverage 1— Legal & Forensic Ir�formation Technology Review $50,000 Coverage 2— Notification to Affected $5,000 per Coverage 1- Personal Data Compromise Individuals Coverage 3— Services to Affected fndividuals Defense and Liability, Member Annual Aggregate (Provides for defense costs (within the limits) and associated liability costs arising from an action brought $50,000 by an "affected individual." This can include both settlements with °affected individuals" as well as judgments rendered.) Annual Program Aggregate for all Data Compromise $225,0� Claims NPIP Coverage CoMirmation Pa 6 of 11 5/4t2012 Fuelon Doc 26�782 ������� Non Profit Insurance Program �,�R�i :i1Rl �_�• ■�.'i. �..�, w -n�►��ca� var�n�ge msu�an� L.QVaar�� Insurance Carrier �erican Alternative Insurance Corp, a member of Munich-American Holding Corporation AM Best's Rating A+ XV Policy Number N1-A2-RL-0000013-04 Policy Period 6/1/2012 to 6/1/2013 rogram ReteMion $50,000 Each Occunence $500 Private Passenger Vehicles, Pickups and Vans $2 500 Buses S ecialty Trans rt Vehicles and Vans Member Auto Physical Damage Standard p � , , , Deductiblea exceeding 8 passenger capacity $1,000 All Other Vehicle See Vehicfe Schedule for Deductibles Per Vehicle Co-Insurance None Owned Vehicle APD Limit, Each Occurrence $300,000 Terrorism Included = rsriw��+rf� : Vehicles - Actual Cash Value NPIP Coverage Confirmatlon Page 7 of 11 5/4/2012 F�� Doc #: 2600782 Non Profit Insurance Program ',,,r a y r` �'r x" a'�: � ` �r�me tnsuran�e �c�►rrera�g� :- ` � Insurance Carrier �erican Aitemative Insurance Corp, a member of Munich-American Holding Corporation AM BesYs Rating A+ XV Program Policy Number N1-A2-RL-0000013-04 Policy Period 6/1/2012 to 6/1/2013 Program Retention $50,000 Each Loss Member Deductibles $500 Each Loss � � ' �� � � � Employee Dishonesty $�0,000 Each Occurrence Forgery or Alteration $� �,� Each Ocxurrence Theft, Disappearance and Destruction of Money and Securities Inside and Outside the $25,000 Prsmises Each Occurrence Each Member Theft, Disappearance and Destruction of Insured's Property Inside the Premises, Robbery or Safe $25,000 Burglary of Other Property, Each Occurrence, Each Member Computer Fraud, Each Occurrence, Each Member $25,000 Funds Transfer Fraud, Each Occurrence, Each $25,000 Member Money Orders & Counterfeit Paper Currency Theft, $25,000 Each Occurrence, Each Member NPIP Coverage Confirmatlon Page 8 of 11 5l4/2012 F�ion Doc #: 2800782 Non Profit Insurance Program � � � � �x � ��+��� Liabili�y lnsur�n�e �t��ag+� � Insurance Carrier �erican Alternative Insurance Corp, a member of Munich-American Holding Corporation AM Best's Rating A+ XV Program Policy Number N1 A2-RL-0000013-04 Policy Period 6/1/2012 to 6/1/2013 $50,000 General Liability $50,000 Fire Legal Liability Program Retentions, Each Occurrence $50,000 Employers Liability Each Employee $50,�0 Employee Benefits $50,000 Abuse and Molestation AAember Deductible None � ', " �i� `' �' � � �:; , � t ^ r� a, ;� , ,t � �� : � s .` ;y , r: �„ Commercial General Liability $5,000,000 Each Occurrence, Each Member Each Member General Aggregate Limit $10,000,000 Personal & Advertising Injury, Each Occurrence, Each Member $5,000,000 Damage to Leased or Rented Premises, $250,000 Each Occurrence, Each Member Fire Legal Liability, $�,�,� Each Occurrence, Each Member Failure to Supply Water & Sewer Each Occurrence, Each Member $250,000 Premises Medical Payments, Each Person $5,000 Stop Gap — Employers Liability $� � �� Each Occurrence and Member Aggregate Stop Gap — Employers Liability, Program Aggregate $10,000,000 Each Occurrence and Member Aggregate Employee Ben�t Liability, Each Claim and Member A99��9ate $5,000,000 �� Employee Benefit Liability Retroactive Date 18-MAY-2005 Abuse and Molestation; Each Member, Each Claim �� $2,000,000 Abuse and Molestation; Each Member Aggregate �� �� $4'000,000 Abuse and Molestation Program Aggregate ����� $10,000,000 Abuse and Molestation Retroactive Date 18-MAY-2005 Terrorism Included NPIP Coverage Co�innation Page 9 of 11 5/4/2012 Fusion poc #; Zgpp7g2 Annual Program Aggregate for all General Liability I$50,000,000 Claims NPIP Coverage Confirmation Page 10 of 11 5/42012 F�i� Doc �: 2800782 Non Profit Insurance Program �, ., , . � w� Au#t�rnt�bile �.��b�1Prt� Cc��i��e Insurance Carrier American Alternative Insurance Corp, a member of Munich-American Holding Corporation AM Best's Rating A+ XV Program Policy Number N1-A2-RL-0000013-04 Policy Period 6/1/2012 to 6H/2073 Program Retention $50,0� Each Occurrence Member Auto Liability $2'S00 Buses, Specialty Transport Vehicles, and Vans exceeding 8 passenger capacity Standard Deductible See Vehicle Schedule for Deductibles Per Vehicle �r"�rit ° `� �,� �. ? Automobile Liability $5,0�,000 Each Accident or Loss Uninsured & Underinsured Motorists $1,000,000 Bodily Injury Each Accident or Loss Non-Owned / Hired Auto Liability $5,� � Each Accident or Loss Garagekeepers Liability $1,000,000 Garage Liability $1,000,000 $250,000 per oax�rrence Hired Auto Physical Damage $500 deductible Auto Medical Payments, Each Person $5,000 Terrorism Included NP�P Coverage Cor�firmation Page 11 of 11 5/4/2012 Fusion Doa #: 2600782 NPIP 5/4/2012 Non Profit Insurance Program Princeton Excess 8� Surplus Lines Ins Co, a member of Insurance Carrier Munich-American Holding Corporation (Non-admitted at this time, Coverage Form is not available outside of NPIP program & not subject to guaranty fund) AM Best's Rating A+ XV Policy Number N1-A3-RL-0000060-04 Policy Period 6/1/2012 to 6/1/2013 Program Retentions $50,000 Each Claim Member Deductible $1,000 Each Claim .a�.�u p ,q�. ,�.,,�,� . . �: ��,. ,.,,', w� � � R �.� r Non Profit Directors, Officers and Employees Liability, including Employment Practices Liability and Third $5,000,000 Party Employment Practices Liability Each Member, Each Claim, Member Aggregate Fiducia Liabili , Each Member, Each Claim �,�.� Fiducia Liabili Member r ate �,�,�� Annual Pros�ram Aaareaate $40_000_000 Terrorism Retroactive Date Sexual Harassment Each Member, Each Claim Sexual Harassment, Annual Aggregate Each Member Sexual Harassment Retroactive Date _ � '"" q�Uns Included 6/1 /1986 ��� ��� 18-MAY-2005 scte �o+�"' Program Retentions $50,000 Each Claim Member Deductible $1,000 Each Claim Miscellaneous Professional Liability, Licensed Counselors / Dental Hygienists / Therapists /$5,000,000 Nurses / EMTs / Paramedics / Psychologists Each Member, Each Claim, Member Aggregate Annual Program qggregate $40 000 000 , , Terrorism Included Retroactive Date 18-MAY-2005 ; '"' � ,Nl�td! }�+�tr'!". _. Coverage Confirmation Fusion Page 12 of 11 Doc #: 2600782 t�'on Profit Insurance Progranr Fuslon PO Box 23934 Federal Way , WA 98093 Policy Pfjective �hre - 06-'DIi101: ro Oe-ot-101 ± I This axcel tlocument p wrlEe prdx0ed. To meka changee or vbw hlGtlen columns, copy tfie snUro woACMSN aM1 pea0e lo a�rew eMN in orN� to romwe protactlan. Pha�s �ubmR any ehanpq In the lormat of Mfs vrorkeheet anC intlkatn atlE, ONete, a amenC In �olumn B. Fw ezposuree to be addeC, un�kle all �olumns N ortler to eee all tlate fkids an0 insert new rowe ffi the bottom W Me ahest. Po� chanpee, piwae hlpMlpht flsWe to be uptlah0. ScheCUb ch�npea can ba niso be prhrted entl fazetl � 509-754-3406 or scannetl antl o-mailetl to rhuhnan@caMlsltlsolutbne.com. Thank you. 320 PM Page i of 1 4/9/2013